One of the long recognized perils of medical imaging is the use of ionizing radiation, which has been shown to be associated with carcinogenesis. A number of diagnostic medical imaging modalities and applications utilize ionizing radiation including radiography, mammography, computed tomography (CT), nuclear medicine, and other forms of molecular imaging. In addition, therapeutic radiology utilizes ionizing radiation for treatment in patients with various forms of cancer. Collectively, these diagnostic and therapeutic medical applications pose significant iatrogenic risk to the patient, and must be justified through risk-benefit analysis to substantiate the medical efficacy of use.
Thus, while radiation safety and medical imaging quality are often viewed in isolation, the reality is that they are often directly related to one another. A given medical imaging procedure (e.g., abdominal CT examination) is associated with a quantifiable amount of ionizing radiation, which is dependent upon the acquisition parameters selected, the technology utilized, and various attributes of the patient on which the examination is being performed. If one were to attempt to adjust the acquisition parameters in an attempt to reduce radiation dose, a concomitant effect would take place on overall image quality, largely due to increased noise. As a result, attempts to modify radiation dose (to improve radiation safety) without determining the resultant impact on image quality are somewhat misguided. Radiation dose and image quality are inextricably related to one another and as a result should always be considered in combination.
A number of recent medical, political, and societal initiatives are underway to analyze the use of ionizing radiation in medicine. While these initiatives are arguably long overdue, minimal technology development and few industry-wide standards are in place to provide the requisite infrastructure to maximize the likelihood of success. In particular, long-term success requires a mechanism to prospectively record and analyze individual and cumulative radiation dose exposures associated with medical practice.
While these efforts are underway for creation of radiation standards in medicine, parallel efforts are being made to objectively quantify and analyze quality within medical imaging. The overarching theme in such an endeavor is that improved quality ultimately translates into improved clinical outcomes. The parallel efforts aimed at improving radiation safety and quality in medicine have been encouraged and accelerated by a number of high profile publications issued by the Institute of Medicine, which has cited the unusually high number of errors in medical practice resulting in excessive morbidity and mortality. These publications have called for sweeping reforms in medicine aimed at improving patient safety, quality, and accountability.
Accordingly, a method and apparatus for quantifying radiation safety in medical imaging is needed, where objective data is created for each individual imaging procedure related to acquisition parameters, radiation dose, and clinical data related to exam selection and performance. Further, a method and apparatus to calculate cumulative radiation dose based upon an individual patient's entire medical record, along with occupational and environmental exposures, to calculate a dynamic cumulative radiation-induced carcinogenesis risk, is also required.